Resources for Clinicians & Front-line Workforces
Clinicians, including psychologists, psychiatrists, emergency medicine specialists, GPs and nurses, have important roles to play in supporting the mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander people, and in preventing suicide.
Other front-line workers who provide services to Indigenous people can also make essential contributions. Social workers, youth workers, and any staff who support community programs and services, need to understand how Indigenous people may exhibit distress and how to respond to individuals, families and whole communities.
For some professionals, supporting Aboriginal and Torres Strait Islander people’s mental health and social and emotional wellbeing will be part of their education, training and supervision. For many others, their development in these domains will occur in the workplace, with limited formal oversight.
All workforces need to understand how to work with Indigenous people in a culturally responsive and safe way that supports positive and trusting relationships.
This section of the Manual includes resources that apply in all these situations.
Cultural Understanding & Respect
Promoting Resilience & Preventing Suicide
Supporting the social and emotional wellbeing of Aboriginal and Torres Strait Islander youth
The Strength Within: Social and Emotional Wellbeing Workforce Development Program
Our Healing, Our Future, shaping strategies with our young people
Responding to Crisis
Responding After Suicide
Staying Safe & Well: Self-care for practitioners
Keep yourself healed
Clinical Checklists & Toolkits
Policies & Position Statements
Policies and positions on Aboriginal and Torres Strait Islander people’s mental health and social and emotional wellbeing.
Professional bodies and sector peak organisations have a strong influence on how their members practise. This is true at an individual level, in terms of professional standards and continuing professional development. It also applies at an organisational level, as service providers influence and are influenced by the collective decisions of peak groups.
This section of the Manual outlines the policies and positions of key groups in relation to Aboriginal and Torres Strait Islander people’s mental health and social and emotional wellbeing. It highlights the commitments of these groups to improving outcomes for Indigenous people, and describes the expectations on their members.
ABORIGINAL & TORRES STRAIT ISLANDER CLINICAL AND PEAK GROUPS
Australia has multiple Indigenous organisations which focus holistically on the health, mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander people, and/or on the education and employment of Indigenous people in health professions. These include:
NACCHO represents the Aboriginal community-controlled health organisation (ACCHO) sector, which offers primary health-care to Indigenous communities across Australia. With 143 member organisations, NACCHO is active in:
- Policy development and advocacy – giving voice to the interests of Aboriginal and Torres Strait Islander peoples around health and wellbeing issues
- Representation – speaking on behalf of the ACCHO sector and supporting delivery of primary healthcare services.
- Raising awareness – through projects that address Indigenous health priorities
- Building partnerships – between governments and other groups to improve health outcomes
- Information dissemination – to ensure the ACCHO sector is informed about relevant government policies.
NACCHO addresses mental health, social and emotional wellbeing and suicide prevention within a holistic view of health care that emphasises Indigenous self-determination and governance as important contributors to improved outcomes. It makes frequent submissions to government policy processes that may affect the health and wellbeing of Aboriginal and Torres Strait Islander people.
AIDA is the national body representing Aboriginal and Torres Strait Islander doctors and medical students. It promotes population parity of Indigenous medical students and doctors, as a means of achieving a culturally safe healthcare system and equitable health and life outcomes for Aboriginal and Torres Strait Islander people.
Among its policy platforms, AIDA advocates for the up-skilling of Indigenous doctors and medical students to carry out Indigenous-led research on issues identified by Indigenous people as health priorities.
These are articulated in AIDA’s Research Agenda, and include social and emotional wellbeing and mental health, which AIDA describes as, “distinct from social and emotional wellbeing issues, much as the two interact and influence each other. Even with good social and emotional wellbeing, individuals can still experience mental illness and individuals with a long-term mental health conditions can live and function at a high level with adequate support. The mental health of Aboriginal and Torres Strait Islander people must be improved.”
AIDA’s policy statements include:
- Aboriginal and Torres Strait Islander doctor mental health and emotional wellbeing in the health care sector (2017)
- Ethics in clinical triaging frameworks: Aboriginal and Torres Strait Islander Peoples (2020)
AIPA provides leadership on issues related to the social and emotional wellbeing and mental health of Aboriginal and Torres Strait Islander peoples. Its aims are:
- Aboriginal and Torres Strait Islander people will have access to equitable, timely, safe, sustainable, evidence-based psychological care that respects and promotes their cultural integrity, regardless of where they live.
- Psychology in Australia will be responsive to Aboriginal and Torres Strait Islander cultures, values and belief systems and will be grounded in holistic Indigenous perspectives and the determinants of social and emotional wellbeing.
- The number of Indigenous entrants into undergraduate and postgraduate psychology programs, across all specialties, will increase and parity within the profession will be improved.
- AIPA will be the professional body responsible for quality control of workshops and training programs related to the application of psychology in Aboriginal and Torres Strait Islander contexts.
- AIPA will engage in research to generate improved policy and social and emotional wellbeing and mental health outcomes for Aboriginal and Torres Strait Islander peoples.
CATSINaM is the peak advocacy body for Aboriginal and Torres Strait Islander nurses and midwives in Australia. Its priorities are to:
- Develop and support recruitment and retention strategies for Aboriginal and Torres Strait Islander nurses and midwives
- Inform national Aboriginal and Torres Strait Islander health and education policy
- Provide a cultural hub for resilience and leadership development
- Inform best practice in culturally safe learning and service delivery environments
CATSINaM advocates for cultural safety and the social and emotional wellbeing of Indigenous nurses, midwives and students including through its:
- A Guide for Universities and Health Services to Create Culturally Safe Clinical Placements for Aboriginal and Torres Strait Islander Nursing and Midwifery Students (2018)
- Aboriginal and/or Torres Strait Islander Cadetship and Transition to Professional Practice Programs: Guiding Principles and a Framework for Implementation (2014)
- Nursing and Midwifery Aboriginal and Torres Strait Islander Health Curriculum Framework (2014)
IAHA is a national, member-based organisation that leads sector workforce development and support, to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Members work in sectors including health, mental health and social and emotional wellbeing, disability, aged care, education, justice and community services.
IAHA supports Aboriginal and Torres Strait Islander allied health students and graduates, augmenting existing professional development, educational and cultural support structures. It also supports allied health workers and organisations more generally as they work to improve the health and wellbeing of Aboriginal and Torres Strait Islander peoples.
It advocates for its members and for improved health of Indigenous people, including through policy statements:
- Cultural Safety Through Responsive Health Practice (2019)
- Racism in Health (2019)
- Changing the Conversation: Strengthening a rights-based holistic approach to Aboriginal and Torres Strait Islander health and wellbeing (2013)
The LIME Network advocates for improved teaching and learning about Indigenous health in medical schools, as well as for best practice in the recruitment and retention of Indigenous medical students and trainees. It is a program of Medical Deans Australia and New Zealand, and is funded by the Australian Government Department of Health.
Its resources include:
- A Curriculum Framework for developing a medical school curriculum that teaches Indigenous health in a holistic, inclusive and culturally responsive way.
· A Critical Reflection Tool to help medical schools identify areas of strengths and areas that need improvement in their teaching of Indigenous health.
Gayaa Dhuwi (Proud Spirit) Australia is a national Aboriginal and Torres Strait Islander social and emotional wellbeing, mental health and suicide prevention leadership body. It is governed and controlled by Indigenous experts and peak bodies working in these areas, promoting collective excellence in mental health care. Its Gayaa Dhuwi (Proud Spirit) Declaration is an agenda for reform of mental health, social and emotional wellbeing and suicide prevention service delivery to Indigenous people based on five principles:
- Recognising Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and healing in all parts of the mental health system
- Combining clinical mental health perspectives with Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and healing combined to improve outcomes for Indigenous people.
- Combining clinical mental health perspectives with Aboriginal and Torres Strait Islander concepts of social and emotional wellbeing, mental health and healing combined to guide the assessment of programs for Indigenous people.
- Ensuring Aboriginal and Torres Strait Islander presence and leadership throughout the mental health system to improve accountability and outcomes for Indigenous people.
- Supporting and valuing Aboriginal and Torres Strait Islander leaders and their influence within the mental health system.
The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions including the forced removal of children from their families. It provides an environment for Stolen Generations survivors and their families to speak for themselves, tell their own stories and be in charge of their own healing. It also conducts research and advocacy in Indigenous healing.
The Healing Foundation provides many resources on:
The Coalition of Peaks is made up of more than 50 Aboriginal and Torres Strait Islander community-controlled peak and member organisations across Australia that have come together as an act of self-determination to work with Australian governments on a new National Agreement on Closing the Gap, agreed in 2020.
Through a 2019 Partnership Agreement, the Coalition of Peaks works with the Council of Australian Governments (COAG) to share decisions about the design, implementation and monitoring of all Closing the Gap strategies and policies, and will lead three-yearly progress reviews for the 10-year life of the Partnership.
Closing the Gap includes 16 targets, including Target 14: Significant and sustained reduction in suicide of Aboriginal and Torres Strait Islander people towards zero.
As well as these specific targets, the Coalition of Peaks will drive the adoption of four Priority Reforms relating to Indigenous leadership and self-determination.
MAINSTREAM CLINICAL AND PEAK GROUPS
Mainstream clinical professional representative organisations may be less focused on and/or less capable in supporting Aboriginal and Torres Strait Islander people. The intersection between clinical and cultural support may sometimes be a particular challenge for mainstream clinicians.
Published policies and positions with regard to the mental health and social and emotional wellbeing of Aboriginal and Torres Strait Islander people are summarised here.
The RANZCP’s Aboriginal and Torres Strait Islander Mental Health Committee includes Indigenous psychiatrists, non-Indigenous psychiatrists who work closely with Aboriginal and Torres Strait Islander people and communities, and Indigenous community members who work in mental health service provision and policy development.
Its Ethical Guideline 11, Principles and Guidelines for Aboriginal and Torres Strait Islander Mental Health (revised 2014), applies to all psychiatrist members and expresses a progressive, holistic understanding of Indigenous people’s mental health and social and emotional wellbeing. The guidelines acknowledge the continuing effects of historical trauma, and cultural respect - including for Indigenous health practitioners and traditional healers as colleagues and equals. They urge psychiatrists to fight systemic racism and, at an individual level, to accommodate Indigenous people’s cultural and language needs in the context of clinical consultations by seeking out Indigenous collaborators and advisors. They include the following statements:
“Aboriginal and Torres Strait Islander people remain socially and economically disadvantaged and continue to experience the historical legacy of colonisation and the destruction of their culture.”
“Mental health professionals within Australia have been slow to respond to the social and clinical needs of Aboriginal and Torres Strait Islander people and the response has often been from a biomedical perspective ignoring the important cultural, social and historical context of their communities. Such a perspective fails to take into account of the strengths and resilience of cultures and populations.”
“It cannot be assumed that the ethical and clinical models derived from a western individualistic viewpoint can be automatically applied to Aboriginal and Torres Strait Islander individuals and communities. Nor should we assume we have a mandate to automatically apply such models.”
“it is important that the practice of psychiatry instils awareness and acknowledgement of the psychiatrist’s own cultural assumptions … particularly given the asymmetry of power that is often amplified in interactions between mental health professionals and Aboriginal and Torres Strait Islander people.”
RANZCP’s Position paper: Aboriginal and Torres Strait Islander mental health workers (August 2016) was developed “in response to a general sense of frustration with often inappropriate utilisation or consultation with, as well as the lack of recognition of the value and skills of, Aboriginal and Torres Strait Islander mental health workers by other professionals and managers in health services.” Consistent with Ethical Guideline 11 (above), the position paper offers guidance for psychiatrists and the broader mental health sector in working respectfully with Indigenous mental health workers. It also calls for appropriate inclusion of their expertise in clinical teams, the creation of appropriate career paths, and pay equity.
The APS promotes its advocacy on Indigenous issues; among its public actions it has made a formal apology to Aboriginal and Torres Strait Islander people and funded a bursary for Indigenous psychology students. It also has a Reconciliation Action Plan.
- working with Aboriginal and Torres Strait Islander people;
- Medicare items for Aboriginal and Torres Strait Islander people;
· and ethical guidelines.
The Royal Australian College of General Practitioners has a Faculty of Aboriginal and Torres Strait Islander Health. Its Council is chaired by Wiradjuri man Associate Professor Peter O’Mara and includes GPs and representatives from NACCHO and AIDA.
RACGP has shown support for the ACCHO sector through its 2014 position statement Building sector capacity through stronger investments in the Aboriginal Community Controlled Health Services, which advocated for additional funding for physical infrastructure, practitioner education, long terms planning and building relationships and capacity.
It has also advocated for more diligent identification of Indigenous people in general practice through improved training for GPs to ask about Aboriginality, and has made strong statements about culturally safe GP services, Aboriginal involvement in policy and practice reform and racism in health services.
The first point in its general statement on Aboriginal and Torres Strait Islander Health, adopted in 2010 and revised in 2017, endorses Aboriginal people’s right “to enjoy ‘the highest standard of health’ including not just the physical wellbeing of the individual, but also the social, emotional and cultural wellbeing of the whole community, so that each individual is able to achieve their full potential and thereby contribute to the total wellbeing of their community.”
Aboriginal people are visible in most but not all of the RACGP’s advocacy. For example the wellbeing needs of Aboriginal people are included in statements about child health and maternity care but not in its policy on GP-led aged care.
The RACGP has advocated consistently and forcefully for Aboriginal people’s self-determination and access to culturally safe services through its submissions to government policy processes, including the current review of Medical Benefits Scheme items – to which it has recommended a Medicare rebate for social and emotional wellbeing support services, which could be delivered by a range of professionals including traditional healers, and be available for individual or group consultations.
The Australian College of Emergency Medicine, which represents emergency department doctors, notes that Indigenous people use Emergency Departments almost twice as frequently as non-Indigenous people - representing 3 per cent of the population but 5.6 per cent of ED visits. They are more likely than other people to attend an ED for psychiatric illness (3.7% vs. 2.7%); alcohol/drug misuse and alcohol/drug-induced mental disorder (2.7% vs. 0.8%); and social problems (0.9% vs. 0.3%). On the basis of these differences ACEM is advocating for:
- increased awareness and respect of Aboriginal and Torres Strait Islander cultural needs in EDs;
- more Indigenous Health Liaison Officers to be employed in EDs;
- improved data collection of ED patient ethnicity;
- improved emergency medicine physician and trainee knowledge of Aboriginal and Torres Strait Islander health issues and outcomes.
ACEM has a Reconciliation Action Plan at the Innovate level, which includes the development of cultural awareness training for emergency doctors and the extension of continuing professional development modules relevant to the needs of Indigenous people, as well as actions to promote Aboriginal culture through signage and promoting employment opportunities for Aboriginal staff at the college, and support for Indigenous emergency medicine trainees.
Its STATEMENT ON CULTURALLY-COMPETENT CARE AND CULTURAL SAFETY IN EMERGENCY MEDICINE (which also applies to Maori and culturally and linguistically diverse people including asylum seekers and refugees) acknowledges the diversity of Aboriginal people while recognising their common experiences: “The health disparities for Aboriginal, Torres Strait Islander and Māori peoples are inseparably linked to the subsequent economic and social disadvantage, institutionalised discrimination and intergenerational trauma.”
This statement is intended to be read alongside the STATEMENT ON THE HEALTH OF THE INDIGENOUS PEOPLES OF AUSTRALIA AND NEW ZEALAND, which states cultural competence is essential to quality clinical care, and recognises the role of families and communities, including “complex relationships and responsibilities”, in Aboriginal people’s wellbeing. It also discusses building design to make EDs more accessible to Indigenous people, including the need for separate women’s and men’s areas.
To provide better emergency care for Aboriginal patients, ACEM also advocates for the employment and support of Aboriginal staff including liaison officers, and collaborations with local communities – particularly the ACCHO sector - as well as availability of resources and materials in Indigenous languages, including via audio.
The Australian Association of Social Workers has not published any recent policy or position papers specifically related to Indigenous wellbeing, but the needs of Aboriginal people feature prominently in many of its broader platforms.
In its Social Work and Mental Health Position Paper it states social workers make up a third of the allied health workforce for public mental health services, and are the fourth largest professional group in the public mental health workforce. It calls for greater collaboration with Aboriginal communities in the development of mental health programs and funding priorities nationally, and for a whole-of-society approach to mental health – which is highly consistent with Aboriginal understanding of social and emotional wellbeing – including:
- recognising the impact of social, economic, and cultural factors on individual and societal mental health and wellbeing
- building on individual and community strengths to empower people to exercise more direction over their lives
- recognising the connection between mental health and personal relationships, housing and employment
Its Reconciliation Action Plan includes strategies to increase and retain the Indigenous social worker workforce, but elsewhere the AASW highlights research that acknowledges: “the profession’s complicity in forcibly removing children from their family, culture and country; in disregarding Aboriginal experience and cultural ways of helping; and in perpetuating the unchallenged influence of Eurocentrism in social work practice and education.”
- the central importance of the ACCHO sector in delivering primary health care, which in turn is the key to good health for Aboriginal people
- self-determination for Indigenous people with doctors in a supporting role
- the social determinants of health
- the importance of the Aboriginal health workforce
- holistic, culturally safe models are essential for physical and mental health
- that extra funding should be available for Aboriginal health until the outcomes gap is closed
The AMA has an extensive body of policy statements and submissions in relation to the health of Aboriginal people.
Its AMA Submission to the Aboriginal and Torres Strait Islander Health Reference Group of the Medicare Benefits Schedule (MBS) Review Taskforce includes a number of mental health related recommendations consistent with Aboriginal people’s understanding of social and emotional wellbeing, including:
- allowing accredited, non-Vocationally Registered (non-VR) GPs to rebate the focused psychological strategies item – recognising the lack of psychological services in many Aboriginal communities
- supporting Medicare rebates for traditional healing
· allowing rebate items for group therapy work by GPs when they work collaboratively with Aboriginal workers in wellbeing groups.
However its 2014 RACP SPECIALIST ACCESS ROUNDTABLE CONSENSUS STATEMENT makes a strong statement about how to promote greater access to specialist medicine for Aboriginal and Torres Strait Islander people, including by supporting the ACCHO sector to be the point of access for those who need to see a specialist.
While the RACP does not directly represent mental health practitioners, its inclusion of paediatrics, neurology, rehabilitation medicine, addiction medicine and public health specialties means its work is highly relevant to the holistic framing of social and emotional wellbeing.
RACP was one of four health peaks (with RACGP, RANZCP and NACCHO) to call the rate of Indigenous youth suicide a national emergency in early 2019.
RACP also acknowledges the circumstances of Aboriginal people within many of its position statements. For example its Employment, Poverty and Health: A Statement of Principles includes acknowledgement that: “Aboriginal and Torres Strait Islander and Māori communities experience additional difficulties related to racism, exclusion, loss of culture and restricted self-determination. These factors contribute to poorer health outcomes in the context of ongoing colonisation.”